OBJECTIVE To d e f i n e t h e microsurgical anatomy and exposure obtained by the maxillary swing approach. METHODS Ten adult cadaver specimens fixed by formalin solution were dissected under 5 to 20 times magnification. The microsurgical anatomy and measurement were performed by mimicking the maxillary swing approach. The anatomic relationship of the muscles, arteries,veins,nerves were carefully recorded. RESULTS The maxillary swing approach provides wide exposure extending from the central base to the lateral cranial base,including turkish saddle,the ipsilateral cavernous sinus,the clivus and C1,the nasopharynx,the pterygopalatine and infratemporal fossa,and the parapharyngeal space,etc. CONCLUSION The maxillary swing approach provides a suitable route for accessing lesions involving both the central and lateral cranial base. The sphenoid pterygoid process,the Eustachian tube,and the lateral pharyngeal wall separates the central cranial base from the lateral cranial base and limits anterolateral access to the central cranial base. Removing the pterygoid process provides exposure extending from the central to the lateral cranial base and allows for wide anterolateral access to the clivus and upper cervical spine. The maxillary swing approach is difficult and limited to reach the poststyloid compartment of the parapharyngeal space,the lateral region of styloid process,the horizontal segment of the petrous carotid.

Object To report the one arm external fixator with skeletal traction of calcanus in treatment of comminuted fractures of tibia and fibula. Method 186 cases of fractures of tibia and fibula were treated by the one arm external fixator with skeletal traction of calcaneus. 42 cases were open fractures, and 142 cases were closed fractures.185 cases were followed up. Results 183 cases of fracture united, and the average healing time was 6 months. By Johner Wrichs score 113 were rated as excellent, 69 good, 2 poor. The infection rate was 17.5%. Conclusion It is convenient and effective to use one arm external fixator with skeletal traction of calcaneus to treat comminuted tibia and fibula fractures.

Objective To explore the effects of different initial treatment protocols on the prognosis of pneumonia in the kidney transplant recipients. Methods Sixty-seven cases of pneumonia following kidney transplantation were divided into case group (34 cases) and control group (33 cases).The patients in case group were treated with Imipenem and Cilastatin, SMX/TMP and ganciclovir,and those in control group received routine treatments. Mortality and length of stay in hospital (LOS)were analyzed. Results Mortality (5.9 % ) and LOS (15 days) in case group were reduced as compared with those in control group ( 18. 2 %, 23 days, respectively) (P＜ 0. 05). Among the patients without severe pneumonia, the mortality and incidence of LOS beyond 21 days in case group (3. 4 %, 1/29; 3. 4 %, 1/29) were lower than those in control group (17. 2 %, 5/29; 37. 9 %, 11/29, respectively) (P＜0. 05). Whether the patients were admitted to hospital sooner or later, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05).Whether the etiologies were determined or undetermined, the incidence of LOS beyond 21 days in case group was lower than that in control group (P＜0. 05). The incidence of LOS beyond 21 days in case group was lower than that in control group among the patients with cardiopulmonary disease (P＜0. 05). Conclusion The initial appropriate treatment would improve the prognosis of pneumonia in the kidney transplant recipients.

Objective To explore the value of combining pulmonary rehabilitation with heat and magnetic vibration (HMV) therapy and tiotropium for patients with stable but severe chronic obstructive pulmonary disease (COPD). Methods This was a paralleled, controlled, randomized study. Thirty-seven patients with stable severe COPD were enrolled and divided into two groups at random. One was the tiotropium group (T group) , while the other combined tiotropium therapy with HMV (the T + HMV group). The time span was 4 weeks. The examinations were performed at week 0, week 2 and week 4. The examinations included pulmonary function tests, arterial blood gas analysis, the 6 minute walking test (6MWT) , Borg's score and St George's Respiratory Questionaire (SGRQ). Results Inspiratory capacity (IC) increased in both groups. Forced expiratory volume in one second ( FEV1.0) , percent predicted FEV1.0 and FEV1.0/forced vital capacity ( FVC) increased significantly only in the T + HMV group. The average parameters of the pulmonary function test in the T + HMV group were significantly higher than in the T group. In both groups, alveolar PO2 ( PaO2) improved but alveolar PCO2 ( PaCO2 ) did not change and in this there was no significant difference between the groups. The 6 minute walking distance increased and the average Borg score decreased in both groups, and there was no difference between the groups. SCRQ dropped more than 4 scores in both groups, but the decrease in the T + HMV group was significantly greater. Conclusions Tiotropium can play an important role in the rehabilitation of patients with stable severe COPD. The combination of tiotropium with HMV therapy is superior to tiotropium alone in pulmonary rehabilitation for stable but severe COPD patients.

BACKGROUND: The different level of proteins regulating cell cycle and theircorrelation is the main criteria to differentiate the benign and malignant cellular proliferation.OBJECTIVE: To investigate the expression status of p21waf1 and p53 in lung cancer as well as proliferating cell nuclear antigen (PCNA)DESIGN:A case-control study.SETTING: Department of Respiratory Medicine, Renmin Hospital ,Wuhan UniversityPAITICIPANTS:This case-control study involved 135 patients who underwent lobectomy or fiberoptic bronchoscopy for primary lung cancer or benign chronic pulmonary diseases at Renmin Hospital of Wuhan University from October 1996 through May 1999. They were divided into two groups: lung cancer group (76 patients, including 56 men and 20 women,aged 18-74 years of age) and chronic pulmonary diseases group (59 cases,including 42 men and 17 women, aged 16-70 years of age).METHODS: Phosphate buffer solution replaced the first antibody as the negative control. Immunohistochemistry was performed using a modified streptavidin-biotinylated peroxidase technique according to the manufacturer's recommendations (Maxim Corporation). For p21waf1 staining, we used hydrated autoclaving as a pretreatment. Antigen retrieval was performed in a standard microwave unit for p53 staining. PCNA staining did not need The ratio of the positive cells indicated by yellowish brown nucleus due to staining was counted for 5 successive high-fold microscopic fields: when it was≥ 10%, it was taken as positive; when it was ＜10%, it was regarded as high-fold microscopic fields for the percentage of the positive cells indicated by yellowish brown nucleus due to staining in each field, and the average value of the five fields was taken as labeling index (LI) for proliferated nuclear antigens.MAIN OUTCOME MEASURES: The expression leyels of p21waf1, p53and PCNA in lung cancer.cancer were 75% (57/76) and 47%(36/76) respectively. The labeling index of PCNA in lung cancer group was significantly higher than that of the chronic pulmonary diseases group (0.44±0.32 vs 0.09±0.14, respectively).significantly higher than that of small cell lung cancer (0.51 ±0.33 vs in lung cancer tissues. In chronic pulmonary diseases group, the expression of p21waf1 and p53 showed a close relationship with PCNA.CONCLUSION: It was found that p21waf1 and p53 were obviously upregulated in lung cancer and the degree of cellular proliferation in lung cancer was rather high. The capacity of DNA damage repair in squamous lung cancer may be stronger than that in small cell lung cancer.

OBJECTIVE:To establish a method for rosmarinic acid in Herba Rabdosiae Serrae. METHODS:HPLC method was performed on the column of Inertsil ODS-SP C18 with mobile phase of acetonitrile-0.4% phosphoric acid(gradient elution)at a flow rate of 1.0 ml/min,the detection wavelength was 327 nm,column temperature was 25 ℃,and injection volume 10 μl. RE-SULTS:The linear range of rosmarinic acid was 5.039-100.776 μg/ml(r=0.999 6),RSDs of precision,stability and reproducibility tests were lower than 3%;recovery was 99.53-104.38%(RSD=2.06%,n=9). CONCLUSIONS:The method is simple with good reproducibility and high accuracy,and can be used for the content determination of rosmarinic acid in Herba Rabdosiae Serrae.

Objective:To detect the related substances in norfloxacin glutamate and sodium chloride injections on the basis of nor-floxacin related substances analysis method described in Chinese Pharmacopoeia 2010 edition to establish a more scientific and feasible method. Methods:HPLC was performed under the following conditions:a Diamonsil C18(2)(250 mm ×4.6 mm,5μm) column, mo-bile phase A of 0. 025 mol·L-1 phosphoric acid-acetonitrile(87∶13), phase B of acetonitrile, with gradient elution at a flow rate of 1. 0 ml·min-1 , the detection wavelength of 278nm and 262nm, the injection volume of 20 μl, and the column temperature of 25℃. Results:Under the HPLC conditions, the samples had good stability and separation. An excellent linear relationship was achieved within the range of 0. 032-3. 179μg·ml-1(r=1. 000 0),the detection limit of impurity A was 0. 159 ng,and the average recovery was 98. 3% with RSD of 0. 64%(n=9). Conclusion:Compared with the existing methods, the gradient elution method is accurate, sen-sitive, specific and reproducible, and can be used in the determination of related substances in norfloxacin glutamate and sodium chlo-ride injections.

Objective To study the expression of TrkB and c-fos in rat auditory cortex after long -term ad‐ministration of sodium salicylate and the mechanisms of salicylate ototoxiclty .Methods Normal adult rats were di‐vided into three groups :normal group without any treatment ,long -term treatment group given i .m .injections , 175 mg/kg ,twice daily at 9:00 am and 6 :00 pm for consecutive 14 days and the recovered group using the same method as the chronic group except that they were sacrificed 28 days after salicylate treatment ceased .After the de‐tection of ABR ,rats were sacrificed after deep anesthesia ,and the auditory cortexes were dissected rapidly .Real-time PCR and Western-blot were explored to detect the expression of TrkB and c-fos .Results The average ABR threshold of normal rats was 36 ± 2 .23 dB SPL .The average ABR threshold of long -term group was 41 .3 ± 3 .31 dB SPL ,which was significantly increased than normal group(P<0 .01) .The average ABR threshold of the recoveredgroup was 38 .6 ± 5 .51 dB SPL .There were no differences between the recovered group and normal group(P>0 . 05) .The expression of c-fos mRNA(1 .24 ± 0 .09)and protein(0 .70 ± 0 .12)in the long -term group were signifi‐cantly increased ,when compared with the normal group .The c-fos mRNA(1 .23 ± 0 .04)and protein(0 .68 ± 0 .08) expression in the recovered group were also significantly increased compared with the normal group .The expression of TrkB mRNA(1 .26 ± 0 .10)and protein(1 .85 ± 0 .17)in the long -term group were significantly increased ,when compared with the normal group .The TrkB mRNA(1 .23 ± 0 .07)and protein(1 .80 ± 0 .08)expression in the recov‐ered group were also significantly increased compared with the normal group .Conclusion The inereased expression of c-fos in the long -term group may be related to the enhancement of central auditory function .The inereased ex‐pression of Trk-B in the long -term group might be involved in instability of synaptic plasticity in tinnitus .

Objective To study changes of auditory brainstem evoked potentials (ABR)and the expression of glial fibrillary acidic protein (GFAP)during the critical period of the development of the auditory cortex in rats. Methods Fifty Sprague - Dawley (SD)rat pups were divided into five groups(n=10 per group):postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group.The rats were decapitated after the evaluation of ABR.The auditory cortex was taken and immunohisto-chemical staining was used to detect the expression of GFAP in rat auditory cortex in each group.The protein ex-pressions of GFAP in rat auditory cortex in each group were tested by western blot methods respectively.ResuIts The ABR thresholds gradually decreased along with the increasing days after the birth.The average ABR thresholds in postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group were (84.5 ± 4.97)dB SPL ,(70.5±3.69)dB SPL ,(58.5±5.80)dB SPL,(37.0±4.83)dB SPL and(35.5±3.69)dB SPL,respectively.There were no significant differences in ABR thresholds between the postnatal 35 days group and the postnatal 42 days group (P>0.05),whereas,significant differences were found among the other groups(P<0.05 or P<0.01.GFAP expression in auditory cortex gradually increased in all five groups.The average integrated optical density (IOD)of postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group were 474.36±234.56,1465.93 ±474.96,2163.06 ± 353.36,6572.01±808.88 and 7244.37±932.90,respectively.The differences among all five groups were statisti-cally significant (P<0.05 orP<0.01 ).The protein levels of GFAP in the auditory cortex of postnatal 14 days group,postnatal 21 days group,postnatal 28 days group,postnatal 35 days group and postnatal 42 days group were 1.00±0.06,3.07±0.07,4.92±0.05,6.88±0.03 and 8.92±0.04.The differences among all five groups were sta-tistically significant (P<0.05).ConcIusion The ABR threshold gradually decreased and GFAP expression in audi-tory cortex gradually increased from postnatal 14 days to postnatal 42 days ,suggesting that astrocytes may promote the development and maturation of the auditory cortex and the auditory central system in rats.

Objective To observe the effects of long term injection sodium salicylate on the auditory brain-stem response(ABR)and expression of glutamic acid decarboxylase -67(GAD67) in rat inferior colliculus .Methods Eighteen healthy Wistar rats were randomly divided into three groups :the sodium salicylate group (intramuscular injection of 10% sodium salicylate ,175 mg/kg ,twice daliy for 28 days) ,the saline group (intramuscular injection with saline on same does at the same time) ,the control group (without any treatment) .The rats received ABR after modeling ,then were decapitated and inferior colliculus tissues were stripped .Western blot was used to study the dif-ferent expression of GAD67 protein levels in the three groups .Results Compared with the saline group and control group ,ABR thresholds of the sodium salicylate group were significantly elevated and latency of wave Ⅲ was aslo sig-nificantly prolonged(P<0 .01) ,while there was no significant difference between the saline group and the control group(P>0 .05) .The inferior colliculus GAD67 protein expression level of sodium salicylate group was significantly higher than the saline group and control group(P<0 .01) ,while there was no significant difference between the saline group and the control group(P>0 .05) .Conclusion Long term injection of sodium salicylate can cause a change in the inferior colliculus of GAD67 protein expression and the up regulation of GAD67 expression may occur as a com-pensatory response to increase inhibiting effect .The change of GAD67 protein expression is likely as a compensatory and regulatory mechanisms for sodium salicylate ototoxicity .